I received and email from blog reader, Jeremy, who had a (L4-L5) lumbar spinal fusion surgery in May this year. For those of you who are not familiar with the surgery, two (or more) vertebrae are surgically connected together so they no longer have mobility. Usually the jelly-like intervertebral disc is removed and replaced with a rigid plastic or metal spacer. This surgery is performed for a variety of reasons, including: scoliosis, degenerative disc disease, herniated disc, and more.
Jeremy has completed physical therapy and is now cleared by his physician to resume light exercise. His question is, what exercise is appropriate for him now? He does have a lot of muscle tightness in his lower back (as expected).
First, an important fact to remember is that the spine does not tolerate bending, twisting or compression well and these movements should be avoided as much as possible. Second, just about all of our spines are somewhat out of alignment and often in a flexed posture (bent forward) due to sitting and gravity. Third, the spine is stiffest early in the morning due to the discs fully hydrating while lying down. As the day goes on, the discs lose hydration and the vertebrae move more easily. That is why most back pain occurs early in the morning or after sitting for a while.
Early exercise should focus on restoring spine alignment and improving hip and shoulder flexibility/mobility. Even though the lower back muscles feel tight, you should not bend, twist, or contort the spine to attempt to stretch out the tight lower back muscles. A neutral (natural, not flexed, twisted, or hyper-extended) spine should be maintained with all exercises as you gradually work on the hip and shoulder muscles. Additionally, self-myofascial release (foam rolling) can be used to loosen the low back muscles, hips and legs.
Below, in the video, is a series of exercises that can be done to loosen up the back (and hip and shoulder muscles that have myofascial connections to the spine) improve flexibility, and prepare for more challenging exercises. After these exercises improve spinal alignment and flexibility, then 'core' stability with a variety of movement patterns (lunging, squatting, lifting,carrying, etc.) can be trained. Always maintaining a neutral spine. This series of exercises can be done a couple times per day (0:15 each session), even early in the morning when the spine and all the muscle are stiffest.